Full-body skin exams detect early skin cancer

Action Points

Note that in this study, dermatologists conducting full-body skin examinations were more likely to detect early stage melanomas than were patients.

Note that the accompanying editorial cautioned against interpreting the results of the small study as definitive. But it concluded that the existing evidence, although not of the highest quality, supports the use of full-body skin exams at present.

Dermatologists conducting full-body skin exams were better at detecting skin cancers than patients themselves in a study that attempts to shed light on a controversial procedure.

The benefit of a doctor's exam was particularly evident with early-stage melanomas that have not invaded below the surface of the skin, according to Jonathan Kantor, MD, MSCE, and Deborah E. Kantor, MSN, CRNP, of North Florida Dermatology Associates.

The findings were published in the Aug. 17 Archives of Dermatology.

About 56% of melanomas were discovered by dermatologists who conducted full-body skin examinations (FBSEs) when patients visited with an unrelated complaint (95% CI 47.6% to 65.1%), the authors reported.

Of the melanomas that had not invaded below the surface of the skin, 60% were detected by a dermatologist (95% CI 48.7% to 71.3%).

"These data suggest that minimizing the substantial public health and financial impact of melanoma may be aided by a full-body skin examination," the investigators wrote.

The use of FBSEs to find early melanomas so that they can be surgically removed is a matter of debate among dermatologists.

While evidence exists to suggest that FBSE is effective for catching skin cancer, a recent report by the US Preventive Service Task Force (USPSTF) concluded that that the evidence was insufficient to conclusively recommend the exam as a routine procedure.

"Our aim was to determine the proportion of patients in a private dermatology practice in whom melanoma was detected but was not the presenting complaint," Kantor and Kantor wrote.

"If a substantial proportion of melanomas are detected only after a dermatologist's examination, this may suggest that FBSE, and not simply a problem-focused approach, should at least be considered for selected patients."

The researchers analyzed 126 melanoma cases diagnosed at the Jacksonville, Fl., practice between July 2005 and October 2008. Of the patients in the study, 51 had invasive melanoma that had spread to deeper layers of the skin and 75 had melanoma that remained on the surface of the skin (in situ tumors).

In addition to finding that dermatologists were more likely to discover melanomas, particularly when the tumor was in situ, they also found that detection by dermatologists was associated with thinner invasive tumors.

"While self-examination plays a critical role in early detection, prior studies have suggested that physicians, and dermatologists in particular, may be better able to detect melanomas with lesser tumor thickness," the authors wrote.

"Because increasing tumor thickness is closely correlated with decreasing survival, it follows that complete examination plays an important role, particularly in high-risk populations."

However, the authors pointed out that the study was limited by its small sample size as well as its retrospective nature.

In an accompanying editorial, Daniel G. Federman, MD, of VA Connecticut Health Care, and colleagues noted that other influential organizations, including the American Cancer Society and the American College of Preventive Medicine, support selected screening for skin cancer. They said the USPSTF's "less enthusiastic" take on screening may stem from its stringent requirements for strong evidence.

"Unfortunately ... owing to the difficulties of conducting an adequately powered [randomized controlled trial] to demonstrate the efficacy of skin cancer in lowering mortality, such evidence will probably not be forthcoming soon or perhaps ever," they wrote.

They cautioned that while the results of the new study are intriguing, its small size and potential for bias limit its power. They also noted that the evidence is contradictory concerning the relative skills of primary care physicians versus dermatologists at detecting melanomas.

But they also quoted the late astronomer Carl Sagan, who said that "Absence of evidence is not evidence of absence," in their summation of FBSE in screening for skin cancer.

"At this time, we see the metaphorical glass with respect to screening for skin cancer as 'half full,'" Federman and colleagues wrote. "Findings from suitable reports, such as the article by Kantor and Kantor, contribute information that adds incrementally to our understanding of the issues involved. Perhaps we can sip from the glass (i.e., consider FBSE to be a reasonable approach), assuming that future studies will eventually fill the remaining half with fine wine."

No funding sources for the study were reported.

The authors of the study and the authors of the editorial reported no financial conflicts of interest.

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